Cocktail Therapy for Hip Necrosis in SARS Patients

Background: There are no treatment guidelines for hip necrosis in severe acute respiratorysyndrome (SARS) patients. A new regimen of cocktail therapy that consistsof extracorporeal shockwave therapy (ESWT), hyperbaric oxygen therapy(HBO) and oral alendronate was utilized in four patients with eight hips.This study evaluated the outcomes of cocktail therapy with a 4-year followup.Methods: There were 3 women and 1 man with an average age of 26 ± 3.8 years. Eachhip was treated with 6000 impulses of ESWT at 0.62 mJ /mm2 energy fluxdensity in a single session. Each patient received HBO treatment for 100 sessionsand oral alendronate for one year. The evaluations included pain scoreand Harris hip score, radiographs and magnetic resonance imaging (MRI) ofthe affected hips.Results: At the 4-year follow-up, significant improvements in pain score and Harriship score were observed in all cases (p < 0.001). All patients returned towork as healthcare providers. None required surgical intervention includinghip replacement. MRI showed a trend of reduction in bone marrow edemaand the size of the lesion, but no changes in the stage of the lesion.Conclusion: Cocktail therapy seems promising in delaying the disease progression ofSARS-associated femoral head necrosis in the short-term.